<form>
   <select class="focus input">
      <option><?php echo $this->translate('curriculum') ?></option>
      <option><?php echo $this->translate('english') ?></option>
      <option><?php echo $this->translate('secondary_education') ?></option>
      <option><?php echo $this->translate('vocational_education') ?></option>
      <option><?php echo $this->translate('university') ?></option>
      <option>Master</option>
   </select>
   <input class="focus input" type="text" value=" <?php echo $this->translate('fill_your_keywords') ?>" />
   <select class="focus input">
      <option><?php echo $this->translate('procedures') ?></option>
      <option><?php echo $this->translate('australian_study_procedures') ?></option>
      <option><?php echo $this->translate('procedures_visa') ?></option>
      <option><?php echo $this->translate('australian_visas_changed') ?></option>
      <option><?php echo $this->translate('other') ?></option>
   </select>
   <select class="focus input">
      <option><?php echo $this->translate('select_nearest_college_location') ?></option>
      <option>Queensland</option>
      <option>New South Wales</option>
      <option>Victoria</option>
      <option>South Australia</option>
      <option>Western Australia</option>
      <option>Capital</option>
   </select>
   <input class="submit" type="submit" value="<?php echo $this->translate('search') ?>"/>
</form>